Denials Management Specialist

Southwoods Health; Boardman (OR); On-site; USD 45,000 - 65,000; Full time

Job summary

Southwoods Health in Oregon is seeking a Denials Management Specialist to actively pursue payments from insurers by following up on aged, unpaid claims and handling strategic appeals. The role emphasizes proactive communication with carriers and timely resolution to improve cash flow.

You will manage denial worklists, document all interactions, prepare supporting documentation, and collaborate with the billing team to identify and correct billing errors, while staying compliant with OSHA, ODH,

Qualifications

• Completed training or courses in business office operations, computer applications, and medical terminology.
• Collection or billing certification is highly preferred.
• Comprehensive knowledge of the revenue cycle and resolving complex claim issues.

Responsibilities

• Review denial worklists and manage tasks on a daily/weekly basis.
• Contact insurance carriers to determine unpaid/denied account status and navigate payer portals.
• Prepare and submit formal insurance appeals with required documentation.
• Log all communications and maintain detailed notes in patient accounts.
• Investigate billing errors, report to supervisor, and assist with policy corrections.
• Stay updated on insurance policy changes to ensure regulatory compliance.

Skills

Effective communication

Problem solving

Ethical conduct

Education

Training in business office operations, computer applications, and medical terminology

Job description

About the Role:

Southwoods Health is hiring a Denials Management Specialist. In this role, you will be responsible for corresponding with insurance carriers regarding aged, unpaid claims. The ideal candidate will work diligently to secure and expedite payments through proactive follow-up and the strategic appeals resolution process.

• Worklist Management: Review tasks, credit balances, and denial worklists on a daily and weekly basis.
• Payer Correspondence: Contact insurance companies directly to determine the status of unpaid or denied accounts, and navigate online insurance websites efficiently.
• Documentation & Appeals: Prepare, file, and submit formal insurance appeals. Send necessary copies or supporting clinical documentation required by insurance carriers.
• Account Logging: Detailed note-taking of all contact interactions with insurance companies and patients within the patient's account records.
• Claims & Resolutions: Mail insurance claim forms with required attachments, investigate insurance credit balances for resolution, and identify/report billing errors to the supervisor for policy corrections.
• Industry Compliance: Review insurance newsletters and websites regularly for policy updates. Ensure all processes maintain strict compliance with regulatory agencies (OSHA, ODH, BOP, TJC, etc.).

What You'll Need (Qualifications):

• Education/Training: Completed training or courses in business office operations, computer applications, and medical terminology.
• Certification: Collection or billing certification is highly preferred.
• Core Knowledge: Comprehensive knowledge of operational aspects of the revenue cycle and proven measures to take in successfully resolving complex claim issues.
• Key Skills: Effective communication skills, professional problem-solving capabilities, and the ability to maintain a professional demeanor at all times backed by strong ethical principles.

Why Choose Southwoods?

At Southwoods, it's not just about the treatment, but how you're treated. Join our award-winning team today.